The bitter dispute over India’s pandemic mortality

News: How many people died in India as a result of the COVID-19 pandemic? This question has become the subject of a heated argument after the World Health Organization (WHO) estimated India’s pandemic excess deaths at around 4.7 million.

The Government of India issued a strongly worded response, while media houses and editors also jumped in.

What are some factors that need to be considered?

Precisely how many excess deaths occurred in India during the novel coronavirus pandemic will never be known.

All mortality studies, including the latest from WHO, involve choices about what data to include, how to fill gaps, and how to deal with uncertainty; there is always room for debate and disagreement about these choices.

Also, all the estimates come with uncertainty and depend on choices. For example, the WHO estimate drops from 4.7 million to 4.4 million if we consider the pandemic period to span April 2020-July 2021 rather than January 2020-December 2021.

Uncertainty does not mean total ignorance: even the most optimistic reading of the data puts excess deaths at six or seven times official COVID-19 deaths.

How has the Govt responded to such studies?

Several studies, most putting India’s pandemic excess deaths at between three and five million, have been met by strident Government “rebuttals”.

These rebuttals have highlighted the uncertainties (which is valid), and then jumped — without justification — to claiming that there are no excess deaths beyond recorded COVID-19 deaths.

What are the implications of the Govt’s stance and the issues with it?

In its response to the latest WHO study, the Govt has said – “India strongly objects to the use of mathematical models for projecting excess mortality estimates in view of the availability of authentic data”.

The “authentic data” in question is mortality data from the Civil Registration System (CRS), and there are two implications:

• CRS data has been ignored by the researchers;
• CRS data does not support estimates of high pandemic mortality.

Both are wrong.

Issues

– Estimates of pandemic mortality, including those of WHO, are largely data-driven, and the main data-source is the CRS. This data strongly supports estimates of high pandemic mortality.

– The “modelling” that the Government objects to is largely simple data analysis and techniques for filling gaps in the data, entirely unavoidable if we are to use CRS data to estimate excess mortality.

Can a huge mortality surge be explained via increased registration coverage?

It is possible that in some States, registration coverage improved during the pandemic. But, overall, registration probably dropped during 2020.

Data from the Government’s latest National Family Health Survey suggests that deaths that occurred in 2020 were less likely to be registered than deaths in 2019. Birth registration data from the CRS points in the same direction: after increasing by 5% during 2017-18 and 7% during 2018-19, birth registrations fell by 2.5% in 2020.

Way forward

The current state of affairs highlights both the value of India’s CRS data, and the need to strengthen the CRS.

Source: This post is based on the article “The bitter dispute over India’s pandemic mortality” published in The Hindu on 12th May 22.